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  已步入第五个年度的“沪惠保”,保障、服务历经多轮升级迭代。

  新一年的“沪惠保”来了。

  第一财经记者获悉,4月22日,2025年度上海城市定制型商业补充医疗保险“沪惠保”正式开启投保窗口。

  自2021年推出以来,“沪惠保”始终坚持“政府指导、商业运作、惠民利民”原则,今年仍由上海市医疗保障局指导,国家金融监督管理总局上海监管局监督,由中国太保寿险首席承保,联合中国人寿、人保健康、新华保险、平安健康、太平财险、建信人寿、交银人寿、工银安盛人寿等8家保司共同承保。

  从保障内容来看,已步入第五个年度的“沪惠保”,保障、服务历经多轮升级迭代,今年和往年版本相比有何异同?

  据中国太保寿险方面介绍,2025版“沪惠保”继续面向上海基本医保参保人员开放,在坚持不限年龄、不限职业、不限健康状况的参保条件基础上,保费维持129元/人,五大保障责任项仍包含特定住院自费医疗费用保险金、国内特定高额药品费用保险金、质子重离子医疗保险金、海外特殊药品费用保险金以及CAR-T治疗药品费用保险金,起付线、赔付比例与上年保持一致,最高仍可享310万元医疗保障。

  在保费不变的基础上,与2024年相比,2025版“沪惠保”实现了“一增、一享”,保障责任力度更强,健康服务覆盖面更广。

  具体来说,“一增”指的是进一步扩增国内外特药种类,药品适应症全部更新至最新。其中,国内特药种类由原来的41种扩增至48种;海外特药部分药品更新,维持28种;CAR-T治疗药品由原来的3个扩增至4个。

  “一享”指的则是2025版“沪惠保”服务体验持续升级优化,新增原研药9折保供服务,满足不同人群健康生活需求。

  此外,为鼓励家庭参保,2025版“沪惠保”在个人账户家庭共济方面实现扩围,在支持使用医保个人账户余额为本人及直系亲属(父母、配偶、子女)投保的基础上,进一步支持为兄弟姐妹、祖父母、外祖父母、孙子女、外孙子女等多位近亲属投保。

  中国太保寿险数据显示,作为全国参保人数规模最大的惠民保项目,“沪惠保”四年累计参保人数已突破2600万人次。截至2025年3月底,累计赔付金额超22亿元,年龄最小的不足1岁,年龄最大的104岁,单人累计赔付最高超300万元,惠及几十万家庭。

  近日,工业和信息化部发布“关于2025年第一季度电信服务质量的通告”。通告显示,2025年第一季度,互联网信息服务投诉平台【下载黑猫投诉客户端】收到的互联网用户投诉中,服务功能类投诉占比52.7%,个人信息保护类投诉占比17.5%,客服渠道类投诉占比16.5%,其他类投诉占比13.3%。

  通告指出,在接入平台的178家互联网企业中,广东长城宽带等3家企业投诉处理及时率较低,工业和信息化部已督促相关企业妥善处理用户反映的问题。

  据悉,广东长城宽带网络服务有限公司主要被投诉的产品为“长城宽带”,投诉处理及时率为16.4%。另外两家被点名的企业是:真快乐(北京)电子商务科技有限公司,主要被投诉产品为“国美App”,上海巨人网络科技有限公司,主要被投诉产品是球球大作战。

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